TY - JOUR
T1 - Water Exchange Method Significantly Improves Adenoma Detection Rate
T2 - A Multicenter, Randomized Controlled Trial
AU - Jia, Hui
AU - Pan, Yanglin
AU - Guo, Xuegang
AU - Zhao, Lina
AU - Wang, Xiangping
AU - Zhang, Linhui
AU - Dong, Tao
AU - Luo, Hui
AU - Ge, Zhizheng
AU - Liu, Jun
AU - Hao, Jianyu
AU - Yao, Ping
AU - Zhang, Yao
AU - Ren, Hongyu
AU - Zhou, Weizhen
AU - Guo, Yujie
AU - Zhang, Wei
AU - Chen, Xiaolin
AU - Sun, Dayong
AU - Yang, Xiaoqiang
AU - Kang, Xiaoyu
AU - Liu, Na
AU - Liu, Zhiguo
AU - Leung, Felix
AU - Wu, Kaichun
AU - Fan, Daiming
N1 - Publisher Copyright:
© 2017 by the American College of Gastroenterology.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Objectives: Adenoma detection rate (ADR) is a key colonoscopy quality indicator in Western clinical literature. Our low ADR prompted us to assess novel methods to improve performance. Western retrospective reports suggested that water exchange (WE) could increase ADR. However, most of these studies used pain score or intubation rate as the primary outcome. Here we test the hypothesis that WE significantly increases ADR among Chinese colonoscopists and design a prospective randomized controlled trial using ADR as our primary outcome.Methods: This prospective, randomized controlled trial was performed at six centers in China. Screening, surveillance, and diagnostic cases were randomized to be examined by WE or traditional air insufflation (AI) method. The primary outcome was ADR.Results: From April 2014 to July 2015, 3,303 patients were randomized to WE (n=1,653) and AI (n=1,650). The baseline characteristics were comparable. Overall ADR was 18.3% (WE) and 13.4% (AI) (relative risk 1.45, 95% confidential interval: 1.20-1.75, P<0.001). ADR in screening patients using AI was 25.8% (male) and 15.7% (female). ADR in screening patients aged >50 years old was 29.4% (WE) and 22.9% (AI) (relative risk 1.09, 95% confidential interval: 1.00-1.19, P=0.040). The increase by WE was reproducibly observed in all indication categories, and significant in screening and diagnostic cases. The limitation imposed by the unblinded investigators was mitigated by comparable inspection times in cases without polyps, similar adenoma per positive colonoscopy, and reproducible enhancement of ADR and adenoma per colonoscopy by WE across all eight investigators.Conclusions: This prospective study confirms Western retrospective data that WE significantly improves ADR among Chinese colonoscopists. WE may be superior to AI for screening colonoscopy in China. Colonoscopists elsewhere with low ADR might consider evaluating WE for performance improvement.
AB - Objectives: Adenoma detection rate (ADR) is a key colonoscopy quality indicator in Western clinical literature. Our low ADR prompted us to assess novel methods to improve performance. Western retrospective reports suggested that water exchange (WE) could increase ADR. However, most of these studies used pain score or intubation rate as the primary outcome. Here we test the hypothesis that WE significantly increases ADR among Chinese colonoscopists and design a prospective randomized controlled trial using ADR as our primary outcome.Methods: This prospective, randomized controlled trial was performed at six centers in China. Screening, surveillance, and diagnostic cases were randomized to be examined by WE or traditional air insufflation (AI) method. The primary outcome was ADR.Results: From April 2014 to July 2015, 3,303 patients were randomized to WE (n=1,653) and AI (n=1,650). The baseline characteristics were comparable. Overall ADR was 18.3% (WE) and 13.4% (AI) (relative risk 1.45, 95% confidential interval: 1.20-1.75, P<0.001). ADR in screening patients using AI was 25.8% (male) and 15.7% (female). ADR in screening patients aged >50 years old was 29.4% (WE) and 22.9% (AI) (relative risk 1.09, 95% confidential interval: 1.00-1.19, P=0.040). The increase by WE was reproducibly observed in all indication categories, and significant in screening and diagnostic cases. The limitation imposed by the unblinded investigators was mitigated by comparable inspection times in cases without polyps, similar adenoma per positive colonoscopy, and reproducible enhancement of ADR and adenoma per colonoscopy by WE across all eight investigators.Conclusions: This prospective study confirms Western retrospective data that WE significantly improves ADR among Chinese colonoscopists. WE may be superior to AI for screening colonoscopy in China. Colonoscopists elsewhere with low ADR might consider evaluating WE for performance improvement.
UR - https://www.scopus.com/pages/publications/85001799396
U2 - 10.1038/ajg.2016.501
DO - 10.1038/ajg.2016.501
M3 - 文章
C2 - 27922025
AN - SCOPUS:85001799396
SN - 0002-9270
VL - 112
SP - 568
EP - 576
JO - American Journal of Gastroenterology
JF - American Journal of Gastroenterology
IS - 4
ER -